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Maria > Pharmacology IBD + PUD > Flashcards

Pharmacology IBD + PUD Flashcards

1
Q

Infliximab classification

A

T: antirheumatics, DMARDS gastro-intestinal anti-inflm
P: monoclonal antibodies

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2
Q

Infliximab
Indication
Mechanism of action

A

Active rheumatoid arthritis, Crohn’s disease, ulcerative colitis

Neutralizes and prevents activity of TNF-alpha
(one of the cytokines that make up the acute phase reaction)

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3
Q

Infliximab

Side effects/contraindications?

A
  • Contraindicated in HF

Common: fatigue, headache, upper resp infection, abdominal pain, nausea, vomiting
Severe = INFECTIONS, MALIGNANCY

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4
Q

Nursing implications for infliximab?

A
  • Monitor for signs of systemic infection and infusion-related rxns
  • Fatal TB assoc with this drug: recommended to be tested for latent TB before going on it
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5
Q

What are monoclonal antibodies?

A

mAb or moAb

an antibody produced by a single clone of cells or cell line and consisting of identical antibody molecules.

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6
Q

Prednisone
Class
Mechanism of Action/Indications

A

T: corticosteroids, immune modifiers

Used systemically and locally in wise variety of chronic diseaes including inflammatory, allergic, hematolic, neoplastic…etc

Suppresses inflm and normal IR. Replaces endogenous cortisol in deficient states

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7
Q

What drugs should be avoided in pt with PUD?

A

NSAIDs, prednisone….

Others?

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8
Q

Side effects of prednisone?

A

Common: depression, euphoria, anorexia, nausea, dec wound healing, adrenal suppression, osteoporosis, muscle wasting, cushingoid appearance (+ many more)

Severe: peptic ulceration, thromboembolism

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9
Q

Nursing considerations/assessments for pt on prednisone?

A
  • Adrenal insufficiency: hypotension, weight loss, weakness, nauseam vomiting, anorexia, lethargy
  • I/O, edema, rales/crackles
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10
Q

Salfasalazine
Class.
Mechanism of action/indications?

A

T: antirheumatics, gatro-intestinal anti-inflm

For ulcerative colitis, rheumatoid arthritis

Locally acting anti-inflm action in colon, action probably inhibition of prostaglandin synthesis

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11
Q

Side effects of salfasalazine?

A

Common: anorexia, diarrhea, nausea, vomiting, rash
Severe: aplastic anemia, angioedema, anaphylaxis + others

  • Can cause male infertility
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12
Q

Nursing assessments/considerations r/t salfasalzine?

A
  • Assess for allergy to sulfonamides/salicylates (dif breathing, rash, etc)
  • I/O
  • Abdominal pain, stools
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13
Q

What drugs r/t PUD?

A

1) Ranitidine
(Zantac)
2) Omeprazole
3) Aluminum Hydroxide

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14
Q

What drugs r/t IBD?

A

1) Prednisone
2) Sulfasazine
3) Infliximab

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15
Q 
Ranitidine
(Zantac)
Classification?
Mechanism of action?
Indications?
A

T: Antiulcer agent
P: Histamine H2 receptor antagonist

Heartburn, ulcers, GERD, erosive esophagitis

Inhibits action of histamine at H2 receptor sites located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion

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16
Q

Side effects of ranitidine?

A

Common: Confusion

Severe: aarhythmias, aplastic anemia

H2RA can cause Vitamin B12 deficiency (stomach acid helpful in absorption)

-MS changes in elderly (?from class slides)

17
Q

Important nursing considerations/assessments for ranitidine?

A
  • Syrup contains alcohol
  • Epigastric + abdominal pain, frank + occult blood, emesis
  • CBC periodically
  • Geriatric: look for confusion
18
Q

Omeprazole
Class?
MoA and indications?

A

T: anti-ulcer agent
P: PPI

GERD/maintenance of healing in erosive esophagitis; duodenal ulcers

Binds enzyme on gastric parietal cells presence of acidic gastric pH, preventing final transport of H+ across lumen

19
Q

Side effects of Omeprazole?

A

Generally well tolerated
Common: abdominal pain (can exp nausea, diarrhea, fatigue, dizziness)

Severe: pseudomembranous colitis

20
Q

Nursing considerations for omeprazole?

A

= Containdicated in lactation

  • May dec absorption of drugs requiring acidic pH
  • GI + monitor bowel fx: diarrhea, cramping, fever, bloody stools,
  • CBC
  • Do not crush or chew (PPIs enteric coated d/t rapid degredation of drugs in acid conditions of stomach)
21
Q

Aluminum hydroxide
Class?
MoA, indications?

A

T: anti-ulcer agents
P: Antacids-phosphate binders

Lowering of phosphate levels in pt’s with chronic renal failutre.
Adjunct tx for ulcers.

Binds phosphate in GI tract – neutralizes gastric acid and activates pepsin

22
Q

Nursing implications for aluminum hydroxide?

A
  • Pain
  • Monitor serum phosphate + calcium levels when chronic use
  • Chew first, take with glass of water
  • May interfere with other meds
23
Q

Ending of H2RAs?

A

-tidine

24
Q

H2RAs

  • Why are they used so widely?
  • Adverse effects?
A
  • Top pick for PUD b/c safe + effective

- Very rare to have side effects (Cimetidine has highest risk, esp in older adults)

25
Q

WHat is the sole PPI available in injectible form?

A

Prantoprozole

26
Q

When is it best to take PPIs and H2RAs?

A

30-60mins before meals

27
Q

Nursing assessments for acid-controlling drugs (according to Lilley)

A
  • GI fx/changes
  • Liver + kidney fx
  • Cardiac fx esp as relates to hx of Htn, HF, edema, electrolyte imbalances
  • Very important to check drug interactions! (as are many)
  • H2RA: kidney and liver fx, LOC (b/c of AEs)
  • PPI: liver + kidney fx, drug interactions, bowel fx,
28
Q

Why is it important to look at heart + kidney fx related aspects of pt on acid-controlling drugs?

A

Antacids have high sodium content…can lead to exacerbation of these issues

29
Q

What changes in bowel fx are aluminum and magnesium based antacids?

A

Aluminum = constipation

Magnesium = diarrhea
* These often used in combo to balance these issues

30
Q

Special considerations for calcium and sodium based antacids?

A

Calcium - risk for rebound hyperacidity, changes in systemic pH

Sodium bicarbonate - risk of alkalosis and electrolyte imbalance (watch heart + kidney fx)

31
Q

WHat is an important consideration for timing of H2RAs if simultaneously taking antacids?

A

Space 1 hour apart

32
Q

Antacids should be given with?

Why are they not recommended to be given with other meds?

A

At least 240ml of water to enhance absorption in stomach

Affect stomach acidity, thus influencing absorption of many other oral drugs

Maria (14 decks)

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